From telegraph.co.uk
By Lucy Denyer
Poor sleep can increase the risk of obesity, depression, dementia and more. So how can we ensure our eight hours go uninterrupted?
Last Saturday night, I woke up three times in the night to go to the lavatory. Unusual, even for me – but then I had drunk a glass of white wine the night before: always a killer. In the morning I felt groggy and unrested – and not just because of the wine.
We all know that good sleep is vital to our health. Multiple scientific studies have found that poor sleep increases the risk of hypertension, diabetes, obesity, depression, heart attacks, strokes and dementia – quite apart from the short-term consequences of lack of concentration, reduced reaction time, stress and the ability to fight off infection. “The consequences of sleeping insufficiently are so dire that we should be doing anything we can to support sleep,” says sleep scientist Dr Caroline Horton.
But even if you get to bed at a decent time, don’t struggle with insomnia and get the recommended seven to eight hours a night, there are still multiple disruptors.
“We don’t just go to sleep and experience waking up eight hours later feeling restored – sleep isn’t naturally like that,” explains Dr Horton. Our sleep is actually divided into 90-minute cycles that transition through various phases. Stage one is falling asleep, stage two is light sleep, stage three is slow-wave sleep – our deepest sleep state – and stage four is rapid eye movement (REM) sleep, in which we dream. A full night of uninterrupted sleep will cycle through these stages (once we have fallen asleep), but we will often wake briefly between cycles.
These awakenings are, says Dr Horton, “usually micro-awakenings, when we’re just going into or coming out of a period of REM. But if there are other things in the environment that we experience at those times – like outside noise, or an overly warm room – that’s when those things can wake us up”. That’s why, she says, we need to aim for eight hours in bed, which gives us time to get to sleep at the beginning of the night, and for a few awakenings thereafter.
So what can we do to minimise the disruptions and get the best sleep possible?
Waking up to pee
Nocturia, as it’s medically known, is the most commonly reported sleep disruptor, and becomes more frequent as you age, particularly for men, and also if your pelvic floor muscles have weakened. Once you’ve ruled out any underlying medical conditions (diabetes, for example, can cause you to wake up needing to go, as can bladder or prostate issues, so it’s always worth checking in with your doctor), there are obvious ways to mitigate the problem: reducing fluid intake in the hour or so before bed (especially anything caffeinated); ensuring you use the lavatory right before jumping under the covers; and taking any diuretic-containing medicines in the morning.
Taking an afternoon nap can also help: naps allow your bloodstream to absorb liquid, meaning you’ll need to use the bathroom afterwards, which could reduce night-time trips. Elevating your legs while sitting at home also helps with fluid distribution, as does wearing compression stockings. And taking up yoga, Pilates or doing good old kegel exercises can also make a difference, as strengthening your pelvic floor muscles can reduce the need to urinate as frequently.
If you do wake up needing to go, avoid turning on the overhead light – that sends a signal to your brain that it’s daytime. But also, don’t beat yourself up about it if it does happen. “If you get to the point of a regular routine of needing to wee at 3am, as long as you can get back to sleep OK, it’s not the end of the world,” says Dr Horton.
Getting too hot
You know how it is: you go to sleep in the middle of winter with icy feet and the window firmly closed, and wake up several hours later sweating and uncomfortable. Hormonal changes aside, body temperature naturally drops as you sleep – coinciding with the release of the sleep hormone melatonin – so try to resist the urge to turn up the thermostat or leave the electric blanket on, as a cooler room makes it easier to fall asleep and stay asleep: the optimal room temperature is between a relatively brisk 15C and a maximum of 20C.
Dr Horton recommends wearing light cotton pyjamas, and keeping the window open; using breathable bedding can also help. If you do wake up hot and sweaty, do the same things: open a window, take a layer off or run cool water over your wrists to cool yourself down.
Teeth grinding
Teeth grinding, also called bruxism, is often related to stress or anxiety, so it’s worth addressing any underlying issues that could be making you feel tense. Taking certain medications, including SSRI antidepressants can also increase night-time teeth grinding. As ever, practising good sleep hygiene will help: ensure you get to bed at a similar time each night and spend some time winding down before bed.
But it’s also worth visiting your dentist. “Grinding is caused by having imbalanced teeth,” explains dentist Dr Sam Jethwa. “If your bite doesn’t fit 100 per cent perfectly – because of a tooth shape or an awkward filling or a crown – your jaw will try in the night to grind that away.” Dr Jethwa recommends trying to find a restorative dentist with experience with bite, as the danger of, for example, just coming away with a soft mouthguard, is that it tricks the brain into thinking there is something in the mouth it needs to chew – which can increase muscle tension, which can make grinding worse. Dr Jethwa also routinely administers Botox into the masseter muscles of heavy grinders, which reduces the intensity of the clenching – although he says it’s worth trying to fix the bite imbalance to address the underlying problem.
Simpler help could be at hand: Swiss healthcare company Aesyra has just developed a mouthguard and bracelet combination designed to address grinding: pressure sensors are embedded in the mouthguard and when the wearer grinds their teeth, the sensors react and send a signal to the bracelet which vibrates; the bruxism can then be tracked, and during prototype testing, the kit was shown to reduce grinding by nearly 80 per cent – but it’s not available to buy yet.
Loud snoring
We’ve all woken up in the night to find ourselves lying tense with rage at the snoring partner next to us. But short of physically kicking them out of bed, what can we do about it? “Sleep apnoea [when your breathing stops and starts during sleep] is the number one cause of being woken up at night,” says Dr Jethwa.
The most common type is obstructive sleep apnoea – and snoring, gasping, snorting or choking can be an indication that you’re suffering from it, so first of all it’s worth investigating that. It might also be more common in the UK because of childhood orthodontic practice, where often, four teeth are taken out to make room in the mouth before putting braces on. That, says Dr Jethwa, narrows the arch of the mouth, making the palate narrower, restricting space for your tongue and also limiting breathing – hence the snoring.
If you don’t want to contemplate more orthodontic treatment, you can do other things to open up the airways: a dentist can help you with a device to hold the jaw open in a certain position at night. But sleep apnoea is also more common in the overweight, and those who smoke and drink heavily, so those are the first things to address.
Outside noise
Environmental noise, such as air and vehicle traffic, has been shown to increase stage one (light) sleep and decrease slow-wave and REM sleep; night-time noise can also cause extra production of hormones such as adrenalin and cortisol as well as elevated heart rate and blood pressure. In a perfect world, we would all be able to retreat to a completely soundproof bedroom, but if you like to sleep with the window open, or live on a noisy street or with noisy neighbours, you might need to take some mitigating steps.
Earplugs are an obvious first solution, but if they’re not enough, adding a consistent background noise may mask or drown out the sounds you can’t control, and help counteract the harmful effects of noise exposure; you might also find it helpfully distracting. One study found that white noise helped patients having trouble sleeping fall asleep 38 per cent more quickly, and it has also been found to improve sleep quality, although the data is inconsistent, so it might come down to personal preference. You might also want to look into pink noise – such as light rain, or river sounds – which combines louder high-frequency noise with softer low-frequency noise, resulting in a sound that is more even and less layered; or brown noise – rumbling thunder or heavy rainfall – which is deep pitched.
If it’s light that’s bothering you, Dr Horton says a sleep mask can help for two reasons: first because it does the physical job of blocking it, and second because putting it on when you get into bed signifies to your brain that now it’s time to get some rest.
Nighttime pain
“Painsomnia”, as it is commonly known, affects an awful lot of bad sleepers, manifesting itself in everything from nerve and muscle pain to joint and bone discomfort. There are a number of reasons why pain can be worse at night: changing hormone levels can cause bone pain, nerve pain can be caused by changes to body temperature (which means damaged nerves may interpret the change as pain or tingling), and joint pain because the fluid that lubricates joints slows down at night. Your cells also release cytokines, small proteins that help activate your immune system, at night – some of which help make you sleepy, but they can also generate inflammation, which can increase joint pain.
All of which mean that if your sleep is disturbed at the end of the cycle, you’re more likely to be woken up by it. There are things you can do: addressing your sleep position and ensuring your mattress and pillow are supporting your body properly are a good start. Taking glucosamine and chondroitin supplements has been found to help some people with joint pain – these are compounds that are found in cartilage, the connective tissue that cushions and surrounds your joints. Over-the-counter pain medication that reduces inflammation may also be helpful. If you do wake in the night, moving and stretching – peacefully, not vigorously – may help ease the pain, so you can get back to sleep.
Uncontrollable worry
For me, this is the real killer: that 2am racing brain that stops me going back to sleep until the early hours. This, however, falls into the category of things that keep us up, rather than things that wake us up, says Dr Horton. “Only in a few cases do people have such strong mental content that it wakes them up, which is in the case of nightmares,” she says. But there’s no doubt the racing thoughts can interfere with a good night’s rest – and your brain can also get into the habit of then waking up at a certain time. If you do wake and can’t settle your mind down, whatever you do, don’t switch on the light, go and have a cup of tea or, God forbid, switch on your phone. “The more you do that, the more you have a poor association between what bed is for and what you’re doing in bed,” says Dr Horton.
“The best thing we can do to overcome these issues is to relax,” Dr Horton advises. “Give yourself 10 minutes or so of trying to close your eyes and get really comfortable.” CBT therapists will often recommend focusing on what you can feel – like the sheet under you, or the weight of your duvet – rather than what you’re thinking about. If after that time sleep is still not coming, “get out of bed – you don’t want to be in bed and not sleeping. Do something in the dark that’s relaxing – read a book, or listen to a podcast, but not an overly stimulating one.” And notice your body’s cues telling you when you’re tired and it’s time to go back to bed.
Illustrations by Jason Ford
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